Any damage to your vision that is caused by glaucoma cannot be repaired. This is why it is so important to get an early diagnosis so that the glaucoma can be treated and prevented from developing further.
The aim of treatment for every type of glaucoma is to reduce the pressure in the affected eye, called the intraocular pressure.
Eye drops for chronic open-angle glaucoma
Chronic open-angle glaucoma is often treated using eye drops. There are several different types of eye drops that may be prescribed. The choice of eye drops may depend on:
- how your condition is progressing
- whether you have any other medical conditions
- whether you are currently taking any other medications
- whether the eye drops cause any side effects when you use them
The different types of eye drops are described below.
Prostaglandin analogues increase the flow of fluid (aqueous humour) out of your eye, which reduces the pressure within your eye (the intraocular pressure). These eye drops are usually used once a day. Side effects include:
- enlarged blood vessels in the white part of your eye, making your eye look red
- changes to your eye colour - it often gets darker
- eyelashes growing thicker and darker
- eye pain and irritation
- blepharitis - a condition where the rims of your eyelids become red and swollen
- dry eyes
- sensitivity to light
Some types of prostaglandin analogues that you may be prescribed include:
It is thought that beta-blockers reduce intraocular pressure by slowing down the production of aqueous humour in your eye. They are used once or twice a day and can cause side effects such as:
- a stinging or burning sensation in your eye
- dry eyes
- itchy eyes
Beta-blockers can make some medical conditions worse, so do not use them if you have:
See the Health A-Z topic about Beta-blockers for more information about this medicine, including their side effects and what medicines they interact with.
Some types of beta-blockers that you may be prescribed include:
- betaxolol hydrochloride
- levobunolol hydrochloride
Carbonic anhydrase inhibitors
Carbonic anhydrase inhibitors reduce the amount of aqueous humour produced in your eye, which reduces intraocular pressure. These drops are used two or three times a day and may cause:
- a bitter taste in your mouth
- nausea (feeling sick)
- a dry mouth
- eye irritation
Some types of carbonic anhydrase inhibitors that you may be prescribed include:
Sympathomimetics are thought to reduce the rate of production of aqueous humour and increase the flow of aqueous humour out of the eyes. These eye drops are used twice a day and may cause your eyes to become painful and red.
Some types of sympathomimetics can only be used with caution in people who have:
A type of sympathomimetic that you may be prescribed is brimonidine tartrate.
Other treatments for chronic open-angle glaucoma
If the use of eye drops does not improve your symptoms, a different type of treatment may be recommended, such as laser treatment or surgery. These are described in more detail below.
Laser treatment, which uses high energy beams of light, can be used to open up the blocked trabecular meshwork (drainage tubes) within your eye. This is called laser trabeculoplasty.
Anaesthetic (painkilling) eye drops will be put into your eye and a special lens will be placed in front of your eye. The laser will be shone through the lens and will make small holes in the trabecular meshwork. This allows more fluid to drain out of your eye and reduces the intraocular pressure.
An alternative to laser trabeculoplasty is cyclodiode laser treatment. This involves destroying some of the tissue in the eye that produces aqueous humour. It creates less fluid in the eye, which reduces the intraocular pressure.
Laser treatments are usually quick and painless, although during the procedure you may feel a brief twinge of pain or heat. You may still need to use eye drops (see above) after having laser treatment.
A trabeculectomy is the most common type of glaucoma surgery. It involves removing part of the trabecular meshwork to allow fluid to flow through the eye's drainage system. The procedure will be carried out under local anaesthetic (you will still be conscious) or general anaesthetic (you will be unconscious).
Other types of surgery include:
- a viscocanalostomy - this operation removes part of the sclera (the white outer covering of the eyeball), enabling the fluid to filter out of your eye and into your body
- a deep sclerectomy operation - this operation involves implanting a tiny device inside your eye to widen the trabecular meshwork
- an aqueous shunt implant - this operation involves placing a tube device into your eye to increase the drainage of fluid out of your eye
Speak to your surgeon to find out more about your procedure and the risks involved.
If you are having surgery, your surgeon may choose to use anti-scarring medicines. These can improve the success of the operation by preventing scar tissue forming as your eye heals. You may be prescribed:
- mitomycin C or
These medications are unlicensed for the treatment of glaucoma. This means that the manufacturers of these medications have not applied for a licence for their medication to be used to treat glaucoma. In other words, the medications have not undergone clinical trials (research that tests one treatment against another) to see if they are effective and safe in treating glaucoma.
Many experts will use an unlicensed medication if they think the medication is likely to be effective and the benefits of treatment outweigh any associated risk. The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the treatment of chronic open-angle glaucoma. It suggests that these medicines can be used.
If your ophthalmologist (medical doctor who specialises in eye disease) is considering prescribing an unlicensed medication, they should inform you that it is unlicensed, and discuss the possible risks and benefits with you.
Acute angle-closure glaucoma
As acute glaucoma develops rapidly, the condition needs to be treated quickly. The most common forms of treatment for this type of glaucoma include:
- eye drops - see above for further details
- systemic medicines - these are injected into your bloodstream to quickly reduce the pressure in your eye
- laser treatment (called laser iridotomy) - this uses high-energy beams of light to create holes in your iris (coloured part of the eye) to open the angle and enable fluid to flow; both eyes may need to be treated, even if only one has acute angle-closure glaucoma, because this form of glaucoma may develop in both eyes at some point
- surgery - a trabeculectomy (surgery to remove part of the drainage tubes) is the most common form of surgery for acute glaucoma
If you also have a cataract, which is a cloudy patch in the front of your eye, removing it may open the angle in your eye and control the intraocular pressure. See the Health A-Z topic about Cataract surgery for more information about this procedure.
Acute angle-closure glaucoma may also be treated with a medication called a miotic, such as pilocarpine. Miotics work by opening up the blocked trabecular meshwork, which should improve the drainage of aqueous humour out of your eye. You may need to use these eye drops up to four times a day.
Miotics should be used with caution in people who have certain medical conditions, including:
Miotics can also cause some side effects, such as:
- a headache, which may be severe during the first two to four weeks of treatment
- burning or itchy eyes
- blurred vision, which may affect your ability to drive
Treating other types of glaucoma
For other types of glaucoma, your specialist will usually recommend eye drops, laser treatment or surgery. Your treatment will depend on the type of glaucoma that you have and how advanced it is.